Computed tomography in the evaluation of vascular rings and slings

Abstract

Vascular rings are congenital abnormalities of the aortic arch-derived vascular and ligamentous structures, which encircle the trachea and oesophagus to varying degrees, resulting in respiratory or feeding difficulties in children. A sling is an abnormality of the pulmonary arterial system resulting in airway compression. Although several imaging examinations are available for the evaluation of these anomalies, computed tomography (CT) has become the preferred test because of rapid acquisitions, making it feasible to perform the study without sedation or general anaesthesia. Furthermore, CT provides excellent spatial and temporal resolution, a wide field of view, multiplanar reconstruction capabilities and simultaneous evaluation of the airway. In this review, the current role and technique of CT in the evaluation of vascular rings are discussed. A brief discussion of the embryology of the aorta and branch vessels is followed by discussion and illustration of common and some uncommon vascular rings along with critical information required by surgeons.Teaching Points• Computed tomography is valuable in the evaluation of vascular rings.• Due to variable clinical and imaging presentations, diagnosis of vascular rings is often challenging.• Laterality of the arch is critical in surgical management.

Identification and management of fetal isolated right‐sided aortic arch in an unselected population

“…This type of imaging may require sedation of the child and thus in most centers it is offered only in cases of symptomatic infants. Some centers consider performing bronchoscopy if there is a confirmed diagnosis of a DAA, to exclude subclinical airway compression.…”

Multidetector Computed Tomography for Congenital Anomalies of the Aortic Arch: Vascular Rings

“…60,61 Hybrid repair techniques are also being used, such as percutaneous aortic stent placement, percutaneous diverticulum closure, and carotid artery bypass to the right subclavian artery. 59,62 Multidetector computed tomography 10,11,14,15,63 permits the diagnosis and identification of the origin and course of the artery, the degree of compression produced, and the presence of an aortic aneurysm, these are important data for surgery and obviate the need for angiography.…”

“…11,12 Angiography is usually performed to confirm diagnosis but has been relegated to the past by the noninvasive diagnostic capability of magnetic resonance imaging (MRI) and computed tomography. [13][14][15] Bronchoscopy can be used to dynamically check for tracheal compression, as well as to rule out intrinsic disease of the airway. Multidetector computed tomography (MDCT) not only permits diagnosis of aberrant vessels, but provides clear images of the airway, as well as virtual reconstruction of the tracheobronchial tree, enabling the selection of patients for preoperative bronchoscopy.…”

“…Multidetector computed tomography (MDCT) not only permits diagnosis of aberrant vessels, but provides clear images of the airway, as well as virtual reconstruction of the tracheobronchial tree, enabling the selection of patients for preoperative bronchoscopy. [13][14][15] The latest technique to be added to the VR diagnosis arsenal is fetal echocardiography. Incorporation of the 3-vessel and tracheal views 16 and their widespread use in routine fetal heart screening has facilitated the diagnosis of aortic arch anomalies in the fetal stage.…”

Anel vascular: uma causa de desconforto respiratório neonatal frequentemente esquecida

“…A arteriografia percutânea (cateterismo cardíaco) apesar de possibilitar o diagnóstico anatômico de certeza, deve ser evitada, por ser um método invasivo, sobretudo no período neonatal pela morbidade elevada em recém-nascidos de baixo peso 16 . Desta forma a angio-TC e a angio-RM, por permitirem a avaliação anatômica da malformação vascular e afastarem possíveis malformações respiratórias associadas, vem substituindo o uso do cateterismo cardíaco no diagnóstico e planejamento terapêutico dos anéis vasculares 17 . No presente relato, o recém-nascido apresentava baixo peso (1600g), o que inviabilizou a realização da fibroscopia traqueal no nosso serviço (fibroscópio para recém-nascido não disponível), optando-se pela realização da angio-TC devido ao risco aumentado para o cateterismo cardíaco 16 .…”